Rob and Mel kick off this month's episode revisiting the topic of callbacks in the ED. Thanks to SeanG and the other ER docs who wrote in on either side of the debate - the audio Cage Match has begun! The gauntlet is thrown: may the best practice win. Again, if you have concerns, Rob and Mel are calling all our subscribers for a follow up chat about this section to hear what you think (but please don't talk for more than 20 seconds).
Sean G., M.D. - April 3, 2014 1:54 AM
well thanks for the offer guys, I will have to make essentials this year! I would really like to see Mel with a few beers in him, never met an Aussie I didn't like and surely not a drunken one! Thanks Rob!
Sean G., M.D. - April 3, 2014 2:00 AM
Also in retrospect 30 is probably a busy night, but not uncommon forv sure. I believe calling the 1-4 on average people I d/c and was a bit concerned about would be a good idea. Also we could delegate perhaps to our pt advocate the calling of the simpler d/cs...ankle sprains, migraines etc, as Im sure a call from any member of the team would be appreciated. The pt advocate could be given a list of names/numbers/conditions and make a simple call to check in. If he or she gets busy and cant finish the list its not the end of the world. Also creating a text system for the simpler cases is probably reasonable. I think the calling of your few "concerning d/c's personally is doable and wise.. Thanks guys.
Andrea W. - April 13, 2014 5:23 PM
I work in a busy community practice, and I have to agree that calling everyone isn't really feasible (It's not unusual to see 24 patients in an 8 hour overnight shift). But I often will actually make arrangements to call a few of the people I send home - the ones that that might need some extra help or that seemed apprehensive about the plan to go home. Some of them are just completely dumbfounded when I ask for a number where I can call them the next day to check on them, and I find that having that contact planned before discharge often goes a long way for getting the family on board with the discharge plan. (It's also amazing how often the number they gave registration isn't their real phone number either . . . )
Jeffrey A. - April 18, 2014 8:50 AM
I'm now older than many of the commentators but still not that old. Finished residency 1998. "Back in the day"...we were told to be nice to people because they're people and' in the end' it is easier to be nice (saves some complaints and reduces lawsuits). However, we've now gotten to the point that "customer satisfaction" is a nice concept that has gone completely %^&$* out of control. Maybe we need to change our specialty's name. Most of us are no longer emergency departments, we're "Immediate Access Departments". Maybe we need change who we accept into the specialty. Forget crass, deal-with-the-problem, one visit - one complaint, move-on to the next patient, smart, adrenaline junkies and select sweet nurse practitioner's and hand holding, love-to-see-grandma at-home-and-call-me-anytime-you-want-cause-I-love-people, Family Medicine types. NOT the shoulders our specialty was built upon. We used to focus on EMERGENCIES and take care of the rest because we were there and they helped support our income and keep the department open. Now we are so concerned with keeping non-emergencies happy that we dread disrupting the departments flow by having anyone actually sick arrive. EMR's, CPOE. HCAPS, the new ED-CAPS, ICD-10, "quick, sign this", "Walmart's on the phone to see if you can change that antibiotic to one that's made AND insurance covers", "it's just another click", "can room 10's great grandniece have coffee?"...sorry, did I have a patient to see? When will we as a specialty stand-up and define what we are actually here to accomplish. Call back 30 patient's a day per MD (an average community ED shift)? Not a chance.
Steve D. - April 18, 2014 2:11 PM
I'm an avid Essentials (live version when in SF) and EMRAP participant - and I'm also a veterinarian in emergency/critical at a large specialty center. At least 60% of the material translates to what I do, including this (what we would call) management topic. Call backs are an essential way to follow a patient to find out whether your clinical impressions and the patient's response/progression panned out the way you anticipated; I would consider it an essential quality control tool on my medicine since I'm unable to work cases up like you given financial limitations in my industry. Moreover, it allows me to help or advise otherwise if things are not right. I don't call all the cases - only the potentially emergent, complicated, or questionable cases (the FUO, discharged DKA, post-operative bowel RAA, the hit-by-car, toxicity, splint/bandage), or just when I'm curious.
This has an incredible effect on clients: their level of trust in our "post-transaction" sincerity, the perceptions of our profession, and as a business owner, the likelihood that they will return to the ER with a level of trust rather than fear (of cost, what kinda doctor will they get, how their "child/pet" will be cared for). Yes, client service has become in many ways a distraction, but I know how human ER clinicians have developed in how they treat the patient as well as the disease - only benefited care IMHO. Thanks Mel!